Cape Town - The link between heroin and codeine usage has come to light, and the global misuse of prescription or over-the-counter (OTC) pharmaceutical pain relievers, including those containing codeine, has been labelled an increasing public health issue.
A study, published in the South African Medical Research Journal and conducted by experts at the SA Medical Research Council, UCT, Stellenbosch University and the Waterford Institute of Technology in Ireland, aimed to understand the extent of treatment demand related to the misuse of codeine or codeine dependence in South Africa.
Data was collected from centres participating in the SA Community Epidemiology Network on Drug Use in 2014.
A total of 17 260 admissions were recorded, with 435 people admitted for codeine misuse or dependence as a primary or secondary substance of abuse.
The youngest in treatment for codeine misuse or dependence was 11 years old and the oldest 70. More than 74 percent of patients were male.
Of admissions recorded, 124 were in Gauteng, 104 in the Eastern Cape and 92 in the Western Cape.
The study said in response to concerns about codeine misuse and dependence, South Africa was considering introducing regulations to reduce the amount of codeine in a tablet to 10mg and to up-schedule norcodeine and acetylcodeine. “The availability to the public of OTC codeine products has compromised efforts to quantify and address hidden codeine misuse. Codeine misusers vary: some are dependent on codeine, aware of their dependence but using it in response to cravings and avoiding withdrawals,” the study found.
Others unknowingly misused codeine by using it within the recommended limits, but did so frequently and regularly to treat withdrawal-associated headaches; and some deliberately disobeyed codeine product instructions for intoxication purposes. They also said codeine being used as a substitute for heroin in South Africa, when the latter was not available, warranted further investigation.
Shuaib Hoosain, treatment co-ordinator at the Sultan Bahu Centre in Mitchells Plain, said there was a definite link between heroin and codeine usage. He said often when heroin users could not afford the drug they would buy codeine instead.
“Codeine is a very strong painkiller. For heroin users, codeine could be used as a crutch,” he said.
He said with testing systems primarily dependent on urine samples, it was difficult to detect whether an addict used heroin or codeine.
Hoosain said teens were increasingly abusing over-the-counter medication.
Anton Wessels, director of Start to Stop, said because both were opiates, the effect of codeine was similar to that of heroin. He also said that many who were addicted to heroin had started off with a slight addiction to pain medication.
Charles Parry, of the Medical Research Council, said in some cases users of codeine moved on to substances like heroin.
“In our research we found that 11 percent of people in treatment, where heroin was their primary drug of abuse, also reported misusing or being dependent on codeine.
“Misuse of codeine is largely a hidden problem. I believe it is highly likely that misuse is increasing – especially as syrups containing codeine are so readily available and given how easy it is to purchase products, including tablets and capsules containing codeine, over the counter with few questions asked,” he said.
Parry, however, said making codeine a prescription-only medicine would make it less available to people who could not afford to go and see a doctor when they had pain or could not take time off work to do so.
Cape Times